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Otology/Neurotology

(075) Case Report: Temporal Fibrous Dysplasia Complicated by Cholesteatoma and Abscess

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • Samuel Meza, MD

    Resident Anesthesiologist
    Stanford Health Care
    Mountain View, California, United States

    • Co-Author(s)

  • Tirth R. Patel, MD

    Resident
    Rush University Medical Center
    Chicago, Illinois, United States

  • Matthew J. Urban, MD

    Resident Physician
    Rush University Medical Center
    Chicago, Illinois, USA

    • Senior Author(s)

  • EM

    Elias Michaelides, MD

    Associate Professor
    Rush University Medical Center
    Chicago, Illinois, United States

Disclosure(s):
Samuel Meza, MD: No relevant relationships to disclose.
Tirth R. Patel, MD: No relevant relationships to disclose.


Introduction: Fibrous dysplasia of the temporal bone and cholesteatomas may be seen concurrently when abnormal fibrous tissue expands into the external auditory meatus, thus entrapping keratinized squamous epithelium. This case report describes the clinical course of a temporal bone abscess in the setting of acquired cholesteatoma secondary to fibrous dysplasia.

Methods: We describe the case of a 65-year-old male who presented to the neurotology clinic with a four-month history of left-sided craniofacial swelling, otalgia, and malodorous purulent drainage from the external auditory canal. Physical exam was significant for a bony mass completely blocking the left external auditory canal. Imaging revealed cystic fibrous dysplasia along the lateral and superior left squamous temporal bone with multiple areas of dehiscence (including 3 x 1.6 cm dehiscence along the outer table), as well as a large lobulated expansile cystic area within the left middle ear space, concerning for cholesteatoma with potentially superimposed abscess.

Results: The patient agreed to undergo an extended mastoidectomy to help clear infection and cholesteatoma. A post auricular-transtemporal approach to the middle fossa led to the erosive neoplasm, which extended from the mastoid cortex to the tympanic membrane and deep into the antrum, as well as from the zygomatic root to the dura of the posterior fossa and sigmoid sinus. The large tumor was resected and abscess was drained. Meatoplasty and canal overclosure was performed. Wound cultures were polymicrobial, including actinomyces. The patient was treated with intravenous and oral antibiotics. The patient has recovered considerably following his surgery, reporting significant improvement in his symptoms without recurrence while he continues long-term antibiotic therapy.

Conclusions: Fibrous dysplasia of the temporal bone is a rare entity that may be complicated by cholesteatoma and superimposed bacterial infection. Urgent surgical intervention may be necessary to treat these patients.